48 TREMONT ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts CITY OF
=1 T Board of Building Regulations and Standards SALEM
li'.` ' Massachusetts State Buildin Code,780 CMR Revised Mar2017
g
Building Permit Application To Construct,Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only -
2
IZS� Building Permit Number: - Date pied: - — ✓' .
n
Building Official(Print Name) - Signature - - - e O
m
SECTION 1:SITE INFORMATION c
1.1 Property Addr ss: (�1 1.2 Assessors Map&Parcel Numbers .� o
(� J r n
y Gh7
L l a Is this an accepted street?yes_ no Map Number Parcel Number X t
rI
1.3 Zoning information: 1.4 Property Dimensions: W cO
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of R ord: /�
Mr rlta '7 She-ellah it VT
Name(Print) City,State,ZIP
1I5s remvl,4- Sf - 9�g 39S lgI/a
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORle(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ teration(s) ❑ Addition ❑
Demolition ❑ I Accessory Bldg.❑ Number of Units_ Other Specify:
Brief Description of Proposed Work'-:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee:-$ - - Indicate how fee is determined:
2.Electrical $ ❑Standard CitylTown Application Fee -
❑Total Project Cost?(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. ,y'C'Qheck Amount: Cash Amount:
6.Total Project Cost: $a(� ❑Paid in Full ❑Outstanding Balance Due:
rnat t_,�-L�
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 77
y/Z.3//(,
License Number Expiration Date
Name of CSL Holder
Eric W. Palm List CSL Type(see below)_� ( L
No.and Sheet 3 Hilton Sftet
Type Description
U Unrestricted(Buildings u to 35,000 cu.ft.
Salem MA 01970
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
��/A SF Solid Fuel Burning Appliances
"! O 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Atlantic Weatheriration, LLC C Re Z U ��( E
HIC Com HIC Registration Number Expiration Date
pakatr m"RO Name
No.and StrreeeerSa((1JJOOIIii Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance o e building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR G tl���7 CONTRACTOR
R`APPLIES FOR
/ BUILDING PERMIT
L/
I,as Owner of the subject property,hereby authorize 1-i. ev/P-7^
to act on,1 nn
m,,//y behalf,in all matters relative to work authorized by this building permit application.
Pnnt Owners Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of pedury that all of the information
contain d in this acat a and accurate to the best of my knowledge and understanding.
/1
Print Owners or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
v;rrx!.�ass._oa�eca Information on the Construction Supervisor License can be found at e,s.w.mass.=ovldos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
—Massachusetts ®me roveffient Sam le C®retract
Tldstmm aaziffies aH baz nragairrmmnsa fWe
�&aage to protect w.._—� aaoe'sHomelmpmy®mr� ar __
o f ¢r de%He�SmkI h�wW, e�iogtOmnnlork.8a��leatssbw�itd�ah S�
nsrmafaf d®o¢Yw cadmgthe
HomeownerlDformatioD 01�h0°H�noarell�lsalalart�a�zs�7-�n�a���
Name Con ello'Leot'a1ddOD
Q Cm°»Y me
Street Addn� dvnm uses PmtO$g AZ Hm
�. eddtea, r8ntic W!eatt►erise(,i)II L,_,�
Cal, cS�. 5� �Avenue
.P r_ _ - Hu>mesAddtess(anaY
Daflime Phone T•y'Y,r... _. .. .
C.
city/fawn
Mails Address(adiBmmtfmraabove) i�yo zipcde
B
Phone, yy— 8iy
_ Fataal FmplryryerIDerS.S.Nomber
VVNbiIDS�LaQ2o�u Fla@I>pe���aCGT dee
The beam de Mn to do Pktul.Owia(Detaibe in deta0 Wewmk rocpmpt����g the flSPe.6+aa nrm¢nWa¢t:
�I � d smdenf!omeiazem bemsd.t�pddifiartxb
Required
ea
mdwillb "a Conh�nMoratWeLp�t�an, �oposed Stmtmd
avd wiN 6e
(Owaets Who _ omeoaaees agent be Compt¢Saa Sohedala-Thefogowin
esdaded faD Gt6e1a own pxamits WMIM: wlescorcumstaagsboYcoulthecmttattoPsmh�ewd1
ants®ty FDod rIIu°1��
-14GL chapter142A.) . ptDvisioas of
/ � Daewyattwat etorwdlbegncouhscted µark
LI
Total coatm,priretmd / ➢ate when c0loacted wmg wdt be snhneatiallyou'VIelea
The Con Or P9ym®tS orklia
�WPMfarm We worlr,fma;dt Wematedal rmdlabnr
pbemade to W apeciBed abowefOrWetotals®o£ —aceoaNngefollowmg��u,e. �—_(.,
S "Pon
s gamg canRaM(not In etmeed I/3 ofthe total c®haMpdce or by S lheewtaE
aI orderit®s,whichevaisgrtate)
/or up®cemPlctian of
by S
et ,p1 —I "aPon nompletion off,
upon awneom pletianeomftmheu:etrbae"spd'i m(fawfmbidsdfmom
-Vlr.db �
ad for ®a]
eanhaC is eopl¢tdhotupo ssetsfactioa)ewftllld meh r
M men We cor'l e��mmmda
°
IYOTSS:(•)InG°doogall fmm�ce S to ---
nmaeeelthtPrnera(o)®°"hw F rm�-Wdepmitordoy:
whihmmtbespyol ordadieadeavnem rout a or
ac l lmro)thee ens ormycptragCO°.e6eforexmt tre8immaY
s: �wnrew _ s°hedAa -wooreeat ematvm,rde-MY
Sobcontrnchhts-The my - d mnmv
Pa<tyisubeoavactor �oacroi8�rnro be sNet '' ❑ °�Y nterms nrthew alibzed 6yWecooaaMOr 76eY' ° blc farromp)moa ofWe °1�6` h rothemntra
materials and la tmderthisa ttuWeragem to bed w�dgMt7redr¢gm�ess afWe ectiOas d'r
COntmM Acceptnae¢-U on ➢resPaambiefaralllmYmr6toall^x..., Ythird
rntract shall notimplyWat any�L'rram�dn�entbaamesabindta6 emttxM fbr
camFaBY befinesiguiag WiscantraM, oWmsmmtyibasbeenplaced�Wa edce4tw UdessoWMwis¢tmted wiWro this da residence Nmdewthefollmvingeautions audn pmthe
° ➢onY 6epr��s,�gWe
° MakeMake sum_!�_aa�.d�aatd.Take timeta readaad full
nvactors toh thW°m L 'went COnaaeto R Yrmdmstaad it Ask 9uestioas ifeamMim
rugtstaedm ttaaon. 8is unclear.
° shaaan 6yµnhagto Welhrcetarat l0 Grp HomelmProvemmr ConiQetarro9tdacmosthnmeunpmvement owtraetmsand
seeaeO �or�m�Ce7 AskWe �'NOpm 5170,Easion,MA0211��� Yaumaymtprheahuat Wugact9r
° �� PY ofa'brOOfofmsmane¢^dOctan¢n���forhisiosmdnk�p�Y mf 61'WImg617A73-BIg7Or888-Z83-3757.
Glide to the Home�doIl9Wdi0es.Nerd We lmPoaaot mmatimmWatyon emmconfirm wv¢taS4 oras'stO
Impt°eementConaaparlaw. I°fo1°'�on on We reverseside ofWisfutm andgMa copyofWc CousmtM
YouCoo
relay umcel this agteaa®[ifit hag trees third ctor in writing arhisAer m6�ChMapla¢¢aWerthaa the Word 6usiaess dayfo8owiv g�oB�Wisa olftce byO�Ytaail Pasted�bytMs e��°f�OQ.lmwided youaotifyWe
gWesi
1DtDN®7 SIGN7�YSC m�8eettemtarLednoSceafuaQu¢tla mfmm�ir nralaerrbanmangntefthe
r'°mtrmr.wpm°rraa,rem..zrantm,m• �9"RAQ"fddr'g' g�,RftE �Plaoati®ofthisnght
aamP➢eEml Vwe � LAWSPACPSttt
Homrumer's Srgmaae _
ContraMaYs Signaaaa
Daze ,/ 2-
Date II lZ
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an
alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor bas a dispute
concerning this contract,the contmc #}iay�pyb9jMh
dispute to a private arbitration firm which has been approved by
the Secretary of the Execimve O rice Qf o er Affairs and Business Regulation and the consumer shall be required
to submit to such arbi6mtipW,a5i�iblid�$� sachusetts General Laws,cha er 1,2A.
Ho eowner's Signature Contractor's Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute
resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this
section is not separately signed by the parties.
Homeowner's Rights
A homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer
protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement- However,homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about you consumer/homcowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced
documents have been attached. Parties are also advised not to sign the document until all blank sections have been
filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to
be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing
and agreed to by both parties_Contracted work may not begin until both parties have received a fully executed copy of
the contract,and the three day rescission period has expired
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the
homeowner deems him/berself to be financially insecure. However,in instances where a contractor deems him/herself
to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow
account as a prerequisite to continuing the contracted work Withdrawal of funds from said account would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights,or if you wish to obtain a flee copy of "A Massachusetts Consumer Guide to Home Improvement"
contact:
Consumer Information Hotline
Office of Comma Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
6t7-973-8787,888-283-3757 or visit the OCABR website at htto:/hvww.mass.eov/ocabr/
If you want to verify the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home improvement Contractor Law,contact
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the HIC website at httndAlww.mass.2ov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration
htto://db.state.ma.us/homeimproN,ementAicenseelist.asp
For assistance with informal mediation of disputes or to register format complaints against a business,call:
a onsuiner plaint Section
..� ffieeomey General
617-727-8400
AND/OR
Better Business Bureau
508-652-4800.508-755-2548 or 413-734-3114
Wmoa 21-112N-010